Forms and Administrative Manual

For your convenience, we've posted forms that you will commonly use in your day-to-day transactions with us or with your employees. For example, an employee visiting a non-participating dentist may need a copy of a claim form.

We've also included a copy of our Administrative Manual - a valuable first reference tool for detailed enrollment, eligibility and claims information - and our Annual Report.

Please note: Depending on your Internet connection, this file may take a moment or two to download.

If your browser is set up to use Acrobat reader, you can click on the icons below to download an Adobe Acrobat PDF. Then print the form, complete and sign it and return it to us:

Altus Dental Insurance Co., Inc.
PO Box 1557
Providence, RI 02901-1557

Administrative Manual
Claim Form
Handicapped Dependent Form
Authorization to release protected health information
Automatic Payment Form

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